Pathology Of Blood Vessels

•PA THOLO GY of BLO OD VESSELS By: DR. ANTOINETTE T. LEUTERIO

ARTERIES • • • • •

ARTERIOSCLEROSIS ARTERITIS ANEURYSM KAWASAKI DISEASE RAYNAUD’S PHENOMENON

ARTERIOSCLEROSIS • ATHEROSCLEROSIS • MONKEBERG ‘S ARTERIOSCLEROSIS • ARTERIOLOSCLEROSIS

ATHEROSCLEROSIS • RISK FACTORS – hyperlipidemia – hypertension

• VLDL , HDL • TYPE IV • PATHOGENESIS – Lipid infiltration theory

ARTERIOLOSCLEROSIS • Hyaline arteriolosclerosis (nephrosclerosis of kidneys) • Hyperplastic arteriolosclerosis – malignant hypertension

• MONKEBERG’S ARTERIOSCLEROSIS (medial calcific sclerosis)

ARTERITIS • • • •

Polyarteritis nodusa Giant cell arteritidis Thromboangiitis obliterans Wegener’s granulomatosis

GIANT CELL ARTERITIDIS • Temporal arteritis (skip areas) • Takayasu’s arteritis (pulseless disease) • multinucleate giant cells

POLYARTERITIS NODUSA group of systemic necrotizing vasculitides

THROMBOANGIITIS OBLITERANS ( BUERGER’S DISEASE ) - thrombosis of medium-sized vessels (fibrous encasement of artery, vein & nerve)

WEGENER’S GRANULOMATOSIS - necrotizing vasculitis of small arteries and witn granulomatous inflammation

RAYNAUD DISEASE - paroxysmal pallor or cyanosis of the digits of hands or feet

RAYNAUD PHENOMENON - arterial insufficiency of the extremities

• CONGENITAL ANOMALIES: - ARTERIOVENOUS FISTULA abnormal communication between artery and vein

ANEURYSMS ETIOLOGIC CLASSIFICATION – Atherosclerotic aneurysm ( most common) – Syphilitic aneurysm ( thoracic aorta) – Dissecting aneurysm (hypertension)

ANATOMIC CLASSIFICATION – Saccular aneurysm (balloon like-arterial dilatations) – Fusiform aneurysm ( spindle- shaped dilatations) – Berry aneurysm ( Circle of Willis)

VEINS • VENOUS THROMBOSIS – Thrombophlebitis – Phlebothrombosis – Deep venous thrombosis – Predisposing conditions venous stasis / hypercoagulable state ( embolization to pulmonary arteries)

• VARICOSE VEINS – (superficial veins of lower extremities)

LYMPHATICS PRIMARY DISORDERS – Simple congenital lymphedema – Heredofamilial lymphedema ( Milroy’s disease ) – Lymphedema praecox

SECONDARY DISORDERS – Filariasis - (Elephantiasis)

TUMORS of ARTERIES VEINS & LYMPHATICS • BENIGN TUMORS – ANGIOMAS • Cavernous hemangiomas ( Von Hippel - Lindau disease) • Capillary hemangiomas (bleeding)

– GLIOMANGIOMAS (Glomus tumor) – VASCULAR ECTASIAS (spider telengiectasia) • OSLER RENDU- WEBER DISEASE

LOW GRADE MALIGNANT TUMOR – KAPOSI SARCOMA (AIDS)

• MALIGNANT TUMORS – ANGIOSARCOMA (RARE)

HYPERTENSION • DEFINITION - sustained elevation - > 140/90 ; 160/ 95 - diastolic pressure • ETIOLOGY - Essential hypertension (after age 40) primary phenomenon commonest type familial tendency due high dietary intake of sodium ( current theory) – Secondary hypertension ( under age 40)

due preceding disease

HYPERTENSION • MECHANISM of ESSENTIAL HPN (related) - Primary increase in cardiac output reduced sodium excretion - Increase in peripheral resistance increased vasoconstriction agents increased sensitivity of vascular smooth muscles behavioral or neurogenic factor - Multiple defects contribute

HYPERTENSION • PATHOLOGY – Benign hypertension earliest phase, no change later, hyaline arteriolosclerosis – Malignant hypertension diastolic pressure > 110mm Hg fibrinoid necrosis of media w/ marked intimal fibrosis tissues with acute ischemia & microinfarcts elevated serum renin levels

HYPERTENSION • CLINICAL FEATURES – Early hypertension asymptomatic – Hypertensive heart disease left ventricular hypertrophy increased risk of ischemic heart disease – Hypertensive renal disease decreased glomerular filtration progressive glomerular fibrosis elevation of serum creatinine & hematuria – Hypertensive cerebral disease cerebral thrombosis & hemorrhage hypertensive encephalopathy (headache) – Hypertensive retinal disease (“ cotton wool spots “ )

PATHOLOGY OF THERAPEUTIC INTERVENTIONS IN VASCULAR DISEASE

• THROMBOLYSIS - dissolution of a clot - plasminogen activators • BALLOON ANGIOPLASTY AND RELATED TECHNIQUES - dilatation of stenosed artery by balloon catheter - causes plaque fracture • VASCULAR REPLACEMENT - large diameter Dacron grafts perform well than small dia • CORONARY ARTERY BYPASS GRAFT SURGERY

Table 1

TYPES OF HYPERTENSION • DISEASES – ESSENTIAL HYPERTENSION ( adult HPN) – familial – SECONDARY HPN ( children) – MALIGNANT HPN ( > 200/140 mm Hg) • Description • Causes • Pathology

Table 2 MOST COMMON CAUSES & TYPES • DISORDER – Pulmonary embolism – HPN – Valvular lesion

VASCULAR DISEASES • • • • •

ANEURYSM ARTERIOSCLEROSIS HDL LDL VASCULITIS

Table 4

ARTERIOSCLEROTIC DISORDERS • DISEASES – MONCKEBERG DISEASE – ARTERIOSCLEROSIS – ATHEROSCLEROSIS • Description • Risk factors • Pathology

Table 5 ANEURYSMS • • • •

TYPE ATHEROSCLEROTIC ANEURYSM SYPHILITIC BERRY DISSECTING – Description – Predisposing factors – Pathology

Table 6 OTHER VASCULAR DISEASES • VARICOSE VEINS • RAYNAUD DISEASE – Description – Risk factors

Table 7 DISEASES BY VESSEL SIZE • SMALL VESSELS • MEDIUM VESSELS • LARGE VESSELS

Table 8 TYPES OF VASCULITIS • DISEASES – – – – – – –

POLYARTERITIS NODOSA Hypersensitivity Vasculitis Mixed Cryoglobulinemia Wegener Granulomatosis Buerger disease Giant cell Arteritidis Kawasaki disease • Description • Factors • Pathogenesis

Table 9 VASCULAR TUMORS • BENIGN TUMORS – HEMANGIOMA – TELENGIECTASIA – GLOMANGIOMA

• MALIGNANT TUMORS – ANGIOSARCOMA – KAPOSI SARCOMA

CNS

CVS

SMOKI NG

stroke

MI

ALCOHOL

dementia

cardiomyopathy

BURNS LEAD

RESP

RENAL

Hypo - Volemia edema

anemia

Nephritis